Senior Health Clinic Outcome Study

Senior Health & Wellness Clinic Interdisciplinary Team

The Practice Team

The interdisciplinary team approach is a key component to providing high quality ambulatory services for older adults (1). However, putting a group of individuals from different disciplines in the same room does not necessarily mean that they will function well, or at all, as a team. Most medical professionals are not adequately trained in team skills, thus requiring formalized training and ongoing maintenance of team behaviors in the clinic setting. The SHWC Model has focused on the team development element of the model and is grounded by previous work accomplished through the Geriatric Interdisciplinary Team Training Initiative and decades of multidisciplinary team research. Selection of staff and providers with a “team orientation” is an important, initial step in supporting a team that is flexible, open to change, and values the expertise of their colleagues.

Members of our work group desire to be part of a team and value the cohesiveness that it brings. A cohesive team can only function optimally if the members can effectively communicate among themselves, especially under stressful conditions. In the first year of operation, SHWC staff participated in two facilitated workshops which focused on identifying the unique communication styles of each staff person and practiced techniques for communicating with each other, particularly under stress. The staff also participated in a workshop on improving clinician-patient/family communication skills led by a Bayer Institute facilitator. “Principles of Successful Teamwork and Team Competencies,” developed by the Rush University Medical Center GITT Project, was adopted by the team and strategies for addressing those principles are intermittently reviewed and discussed at clinic team meetings. Because of the complexities of the conditions being treated and the numerous processes needed to support that care, the SHWC developed sub-teams to address the critical pieces of the care process. In addition to sub-teams based on discipline, such as nursing, reception, physicians, and ancillary services, specialized sub-teams were developed that focused on the weekly care conference, diabetes, or pain patients and integration of electronic tools to support care.

Crucial to the sub-team development and individual staff is the clear delineation of roles and responsibilities within the team. With good communication skills training, SHWC staff has been able to define and negotiate with other staff the roles that each are expected to fulfill within the team context. Staff members are asked to write their own role description and bring to the larger team for discussion, negotiation, and refinement. Providing an environment where these roles are continuously reviewed and re-negotiated has led to higher employee satisfaction, and, likely, more efficient and effective clinical care.

Finally, the SHWC team has used a Team Measure (unpublished, in development) survey instrument to measure team attributes within the clinic work group and provide “teamness” feedback to the staff. This measure has helped us understand that team attributes are clustered around four domains of team development that appear to have a developmental or hierarchal structure. These domains are cohesiveness, communication, roles clarity, and goals-means clarity. The team attributes within these domains have consistently been observed as the SHWC team has developed. Providing feedback to the team on their level of development has allowed them to strategize about how they might improve team processes.